142. Impact of preoperative chronic opioid therapy on long-term outcomes, reoperations, complications and resource utilization after lumbar arthrodesis

Joshua M. Eisenberg; Piyush Kalakoti; Nathan R. Hendrickson; Comron Saifi; Andrew J. Pugely

doi:10.1016/j.spinee.2019.05.156

Opioid therapy is effective in controlling acute postoperative pain. However, the potential for abuse has been a national concern. Recent clinical trials have questioned the benefit-risk ratio of chronic opioid therapy (COT) in musculoskeletal disorders. The purpose of our study is to elucidate the association of preoperative COT on mid-term to long-term outcomes after primary lumbar arthrodesis. Retrospective, observational cohort study. A total of 28,795 patients registered with the Humana Inc. claims dataset (accessed via the Pearl Diver Research Program) who underwent primary lumbar spine fusion. Ninety-day (mid-term), 1-year and 2-year (long-term) reoperation rates, resource utilization [ED visits, epidural steroid and facet-joint injections], complications [new constipation, acute renal failure (ARF), venous thromboembolic events, infections, postoperative wound, neurologic, respiratory and cardiac complications] and postoperative opioid use across patients on COT versus opioid-naïve (ON) users. COT was defined as patients with an active opioid prescription three months prior to their initial lumbar fusion. Multivariable generalized linear models with risk-adjustment investigated the impact of preoperative COT on outcome measures, Patients undergoing primary lumbar fusion registered with the Humana claims dataset were predominantly women (59%) and aged >50 years (91.4%) with an average cost/claim of $28,631.66. Approximately, 57% of patients were on preoperative COT prior to undergoing lumbar fusion surgery. Multivariable regression models identified COT to be associated with increased risk of 90-day ED visits (OR:1.18; p<0.001), epidural steroid injections (OR:1.44; p=0.032), venous thromboembolism (OR:1.15; p=0.026), and infections (OR:1.16; p=0.020). At 1-year, COT was strongly associated with increased risk of reoperations (OR:1.30; p=0.021), ED visits (OR:1.27; p<0.001), epidural and facet-joint injections (OR: 1.40; p<0.001, OR:1.49; p<0.001), ARF (OR:1.15; p=0.021), venous thromboembolism (OR: 1.11; p=0.042), wound complications (OR:1.15; p=0.01), and infections (OR:1.19, p=0.004). Similarly, at 2-years COT was associated with an increased risk of reoperations (OR:1.25; p=0.009), ED visits (OR:1.27; p<0.001), and other adverse events in addition to respiratory complications (OR:1.20 p=0.002). COT was associated with prolonged postoperative narcotic use at all time points: 90-days, 1-year and 2 years (OR:4.95; p<0.001, OR: 6.34; p<0.001, OR:7.03, p<0.001). Preoperative COT was strongly associated with prolonged postoperative opioid use. The study highlights COT to be associated with inferior mid-term and long-term outcomes and increased resource utilization including ED visits and other pain alleviation modalities after lumbar arthrodesis. Implementing a multidisciplinary opioid-tapering protocol prior to spine surgery can aid in optimizing outcomes and atypical postoperative opioid requirements. This abstract does not discuss or include any applicable devices or drugs.

142. Impact of preoperative chronic opioid therapy on long-term outcomes, reoperations, complications and resource utilization after lumbar arthrodesis

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